20 Questions to Ask Your Insurer During a Claim
smarterclaims teamYou might phone your insurer after a leak, theft, accident, or damaged item, expecting the next step to be obvious. The problem is that an insurance claim can turn on details you may not know to ask about, such as the exact policy wording, the excess, the proof required, or the exclusion being considered.
In this guide, we’ll give you a practical script of insurance claim questions to ask before, during, and after a claim. Rather than heatedly arguing over the phone, the point is to make the insurer explain their position clearly against the policy documents.
What Are Common Questions Asked in Insurance?
Common questions about an insurance claim usually come from the insurer first. They may ask what happened, when it happened, what was damaged or lost, what evidence you have, and whether any policy conditions apply.
While most insurance FAQs on the web focus on explaining what an insurer may ask of you, you also need to know what you should ask them. This means being aware of which section of the policy wording the insurer is using, what proof they need, whether a loss adjuster is involved, and what happens if the claim is delayed or refused.
The starting point is simple: answer the questions you are actually asked, and do not guess. Under the Consumer Insurance (Disclosure and Representations) Act 2012, provided you take reasonable care not to share inaccurate information when you buy or renew your policy, then your insurer cannot cancel your policy or refuse a claim.
With that said, use the questions below to keep the conversation tied to evidence, policy wording, and the insurer's actual decision.
Questions to Ask Before You Submit a Claim
Before you submit a claim, ask questions that pin down the policy section, the excess, and the proof the insurer expects. That helps you avoid sending a vague claim and then having to reconstruct the facts later.
What Is the Excess for This Specific Claim?
Ask which excess applies to the section you are claiming under and where it appears in the policy schedule (the personalized summary for your contract). If anyone uses the word “deductible”, ask whether they mean the policy excess as your own policy schedule is the document that matters for the amount deducted.
Which Policy Schedule Limits Apply to This Claim?
The policy schedule may contain sums insured, single item limits, and excesses that change how much the policy can pay. Ask the insurer to identify the exact limit they say applies, because under-insurance arguments often start with the sums insured shown in the policy schedule and wider guidance on insurance claim issues does not replace that wording.
What Proof Do You Need to Show the Claim Happened?
The proof test has two parts: you have to show the claim happened, and you have to show what it was worth. Whatever the policy documents specify, any reasonable proof can matter, so a bank or credit card statement may stand in for a lost receipt.
Which General Conditions Apply Before I Send Anything In?
The general conditions usually set out practical claims duties, such as notifying the insurer and cooperating with reasonable requests for information. Ask the insurer which condition they are relying on, because broad claims guidance does not replace the actual wording in your own policy booklet.
Are Any Exclusions Being Considered at This Stage?
Ask whether the insurer is already considering an exclusion in the section you are claiming under or in the general exclusions, which are often near the back of the policy wording. If the insurer says an exclusion may apply, ask them to identify the wording in writing, then compare it with practical consumer guidance on problems with insurance policies.
Questions to Ask During the Claims Process
Once the claim is open, the questions should shift from basic cover to handling. The key issue is whether the insurer is dealing with the claim promptly, fairly, and against the actual policy wording.
Under ICOBS 8.1.1R in the FCA Handbook, insurers have to handle claims promptly and fairly, must not unreasonably reject a claim, and must settle promptly. For the insured, those rules are enforceable as though they were law.
Who Is Handling My Claim and What Is Their Role?
Ask whether you are dealing with an internal claims handler, a claim representative, a loss adjuster, a repairer, or another person acting for the insurer. A loss adjuster acts for the insurer, while a loss assessor is appointed by the policyholder.
Has a Loss Adjuster Been Appointed?
If a loss adjuster has been appointed, ask what they have been tasked to assess and whether you will receive a copy of their findings.
Can I Provide My Own Surveyor or Engineer Report?
Ask whether the insurer will consider an independent surveyor's or engineer's report if there is a dispute about the cause of damage. This is often useful in cases where an insurer suggests gradual wear and tear when the actual cause was a sudden storm, for instance.
Am I Required to Use Your Preferred Repairer?
Ask whether the policy wording requires a preferred repairer or preferred network, or whether the insurer is simply recommending one. If the insurer proposes a cash settlement, replacement cost, depreciation deduction, actual cash value calculation, total loss valuation, or market value figure, ask where that basis appears in the section you are claiming under and how it fits the FCA's claims-handling rules.
What Is the Current Timeline for the Next Decision?
Ask what is outstanding, who is responsible for it, and when the insurer expects to make the next decision.
What Further Evidence Do You Say Is Missing?
Ask the insurer to list the missing evidence rather than giving a general request for more information. That keeps the discussion practical, and it also helps if you later need to show the Financial Ombudsman Service what was asked for during the complaints process.
What Should I Avoid Saying to the Loss Adjuster?
Avoid guessing, speculating, or volunteering information that wasn't asked for, because your job is to answer the question as fairly and accurately as you can as per the Consumer Insurance (Disclosure and Representations) Act 2012.
Questions to Ask if Your Claim Is Delayed or Challenged
A delay or challenge does not automatically mean the claim is refused. It does however mean you should move the conversation from general updates to specific reasons, evidence, policy wording, and complaint procedure.
What Is the Specific Reason My Claim Is Delayed?
Ask whether the delay is caused by missing evidence, a policy issue, a valuation dispute, an expert report, or a decision still waiting for approval. If the insurer's answer remains vague, reference the FCA's claims-handling rule to keep the ball rolling.
Are You Treating This as a Coverage or an Evidence Issue?
A coverage issue means the insurer may say the policy does not respond, while an evidence issue means they may accept the type of claim but want more proof. Keeping that distinction clear helps you decide whether to gather documents or challenge policy interpretation head on.
Which Policy Condition Do You Deem as Not Been Met?
Ask the insurer to identify the condition in the general conditions or the section you are claiming under. If the issue is late notification, the insurer can only refuse on that basis if they can show the delay actually cost them something or damaged their position.
Are You Saying I Gave Incorrect Information Upon Signing?
If the insurer raises material misrepresentation, ask for the question you were asked, your recorded answer, and the statement of facts. For the insurer to avoid the policy, they must show a real and substantial misstatement on your part to justify insuring you on those terms and at that price.
What Are the Common Reasons for a Claim Being Rejected?
Common reasons include wear and tear, reasonable care, late notification, missing proof, exclusions in the general exclusions, alleged incorrect information at purchase, and pre-existing condition wording. For reasonable care, what matters is whether the insurer can show you realised there was a risk the claim might happen, then took no steps or only steps you knew would be inadequate.
Steps to Take Before You Reply to a Refusal
Once a claim is refused, do not rush to answer the refusal in general terms. Instead, ask for the documents and explanations that show exactly what the insurer is relying on.
Can You Share the Exact Policy Wording and Exclusions?
Ask for the precise wording in the section you are claiming under and any general exclusions the insurer says apply. A refusal is generally easier to assess when you can compare the insurer's position with the policy documents.
Can You Send Me the Statement of Facts You Are Relying On?
The statement of facts records what the insurer says you declared when you bought or renewed the policy. Make sure to ask for it before responding to any allegation about incorrect information to be compliant under the Consumer Insurance (Disclosure and Representations) Act 2012.
Is This Your Final Response Letter?
Ask the insurer to confirm whether their refusal is their final response letter, or whether your formal complaint is still being considered. This documents the eight-week rule, which you can then raise in front of the Financial Ombudsman Service if you decide to escalate your claim through them.
How SmarterClaims Can Help
If the answers to these questions show that your insurer is relying on a stretched interpretation of the policy, an unclear exclusion, or a refusal you believe is wrong, SmarterClaims can help you put your response in order.
SmarterClaims can review the insurer's refusal letter and the relevant policy documents, identify arguments that may apply to the dispute, explain relevant laws and rules, and draft a structured rebuttal letter that you review, sign, and send yourself.
About SmarterClaims
SmarterClaims is built on the 40-year playbook of Steve Smart, former UK General Counsel at AIG and current Chairman of Lancashire Insurance UK, with a background as a solicitor and Lloyd's broker.
More than £25M has been recovered in refused claims using this playbook. That figure does not promise any outcome in an individual claim.
Final Thoughts
The right insurance claim questions make the insurer explain their position against the policy wording rather than just in broad claims language. That gives you a clearer view of the evidence, the conditions, the exclusions, and the next procedural step.
Finally, remember that a refusal is just your insurer’s official position and not a ruling. If the policy wording, facts, or applicable rules support your case, you can challenge the insurer's decision and ask them to reconsider.
Frequently Asked Questions
You can ask the insurer for the exact reason in writing, make a formal complaint, and consider taking the complaint to the free Financial Ombudsman Service if the process reaches that stage. You can also use a self-help tool like Smarter Claims to prepare a rebuttal based on the policy wording, the refusal letter, and the available evidence.
Late notification only dismisses a claim if the insurer can show the delay actually cost them something or damaged their position. If they cannot show that kind of prejudice, a late report alone may not be enough to justify refusing the claim.